# RECONSTRUCTIVE ORTHOPEDICS, PA

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1659319002
- **Authorized official:** MRS. AMY MICKLE (CREDENTIALING SPECIALIST)
- **Authorized official phone:** (609) 267-9400

## Contact information

- **Practice address:** 4 EVES DR \# A, SUITE 100, MARLTON, NJ 08053-3195
- **Practice address phone:** (609) 267-9400
- **Mailing address:** 4 EVES DR \# A, SUITE 100, MARLTON, NJ 08053-3195
- **Mailing address phone:** (609) 267-9400

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207X00000X | Orthopaedic Surgery Physician | — | NJ | Yes |
| 207X00000X | Orthopaedic Surgery Physician | — | NULL | — |
| 207X00000X | Orthopaedic Surgery Physician | — | — | — |
| 2081P2900X | Pain Medicine (Physical Medicine & Rehabilitation) Physician | — | NULL | — |
| 2081P2900X | Pain Medicine (Physical Medicine & Rehabilitation) Physician | — | — | — |
| 363A00000X | Physician Assistant | — | NULL | — |
| 363A00000X | Physician Assistant | — | — | — |

## Other

- **Enumeration date:** 06/04/2006
- **Last updated:** 11/12/2014

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 35052 | AETNA ID NUMBER | NJ |